My face is like a pepperoni pizza.

Pimples, zits, blackheads – they come in all shapes and sizes and seem to find their way onto my face.

My father’s side of the family had a history of bad acne, but I was hoping it would pass over me. Instead, the genetic pool skipped my brother’s face and landed directly on mine.

When I was in middle school, I began visiting the dermatologist and numerous physicians who would look at my face and utter a quiet “hmm.”

Over time, I used a long list of medications, treatments and topical creams to keep those ferocious bumps from spreading across my face. Some have worked and some haven’t.

Often, I wonder what it would be like to have silky, smooth skin and the ability to cover blemishes with a touch of makeup. It’s hard not to compare my zitty face with others.

Now, I try to keep it in perspective, concentrating on other parts of my life. I’ve spent too many years trying to hide my face, and I wonder how many other people have as well.

According to, 17 million people in the United States have acne, including 85 percent of adolescents and young adults.

Here are some thoughts from professionals about how to look at acne, and what to do about it.

The psychological side

A person’s self-concept or opinion depends on feelings of competence, abilities and body image, according to an e-mail from Leon Rappoport, professor emeritus of psychology.

“If a person’s self-concept is primarily tied to their body image, then any imperfections, such as acne, would likely relate to feelings of depression, anxiety and inferiority,” he said. “But people with a poor body image may compensate by working hard to excel at other activities that are admired or rewarded in our society, and so avoid negative emotions.”

For someone experiencing severe impairments to their mental health, Rappoport said counseling or psychotherapy would be helpful to focus on underlying issues. Many times this includes an overemphasis on physical appearance, not personality or character.

“It isn’t the blemishes – it’s the symbolic meaning they have for the individual,” he said. “Unfortunately, too many people in our society, especially young women, have been brought up and conditioned to judge themselves and others on the basis of their appearance.”

How it happens

The severity and longevity of acne varies with each case, said Tiffany Engelken, nurse practitioner at Advanced Dermatology Center in Manhattan.

Although young people and college-aged students might think they are the only ones who deal with acne, Engelken said some women have acne into their 40s and 50s. Most men outgrow acne in their 20s, she said, but family history and genetics also are factors.

During a woman’s menstrual cycle, acne often flares up because of different hormone levels in the body, Engelken said.

“We’ll definitely see an increase in acne,” she said. “But everybody’s so different. It could be five days prior or during the menstrual cycle.”

A lot of myths surround acne, Engelken said, including what a person eats. Although someone cannot generalize the effects of diet on acne, she said if someone eats chocolate and breaks out, they should stay away from that particular food.

Avoiding touching the face is one way to keep extra oils from finding their way to the skin, but acne does not mean someone has a dirty face, Engelken said.

“I tell my patients, ‘You can’t scrub it off of your face,'” she said. “I don’t see it as a dirt issue, but as a mechanical issue.”

Possible Treatment

With the increased popularity of over-the-counter products like Proactiv Solutions, people can try various brands to thwart acne, but a couple of months will give a final answer.

“If you are using it, give it at least two months,” Engelken said. “If it’s not working after two months, it’s not going to work for you. It does work for some people, though.”

She said two months is the time it takes for new skin to resurface.

When treating acne, Engelken said her goal is to prevent scarring.

Inflammatory acne often is the worst type for patients because it is painful, Engelken said, and topical medication is the best way to treat it.

In severe cases of acne when cysts or nodules are prevalent, Engelken said, “Accutane can be absolutely wonderful.”

Accutane is a type of isotretinoin, according to the Web site, According to the site, this type of medication is used when other treatments, like antibiotics, have failed. With the acne medication, women on the drug are required to be on two forms of birth control because the medicine is known to cause birth defects. This has been a concern for some people looking at the medicine, but Engelken said no long-term effects occur with the drug.

In the past, people also have been concerned about a correlation of depression and Accutane use, but Engelken said the fear is not based on fact. No research has found the correlation to be viable, and she said people do not have to take an anti-depressant while on the medication. Accutane often is used by adolescents already at a high risk for depression, Engelken said. She said young people who begin taking Accutane are self-conscious about their appearance and become happier because when they see the medication begin help, and eventually their acne disappears.

Yet, if someone has a history of depression, Engelken said the medication might not be a good fit for them, but the medication does well on severe acne.

“That’s our big gun.”

Accutane is not a cure, however.

“It does good, but ultimately, we don’t cure acne,” Engelken said. “I tell my patients there’s not a cure for acne, and I can’t consider this a cure.”